Association between axillary lymph node involvement and clinicopathological features of breast cancer among Indonesian women
BACKGROUND Some clinicopathological features play roles in the spread of breast cancer to axillary lymph node (ALN). However, their roles as predictive factors are not well-established. This study was conducted to determine the correlation between the clinicopathological features of breast cancer and the risk of ALN involvement in Indonesian women.
METHODS This cross-sectional study was conducted in Margono Soekarjo Hospital using archival data from January 2017 to June 2018. All subjects with breast cancer who had undergone modified radical mastectomies without any evidence of distant metastasis were included. Chi-square and Fisher’s exact tests were performed to assess the relationship between ALN involvement and age, menopausal status, laterality, tumor size, tumor stage, histological type, tumor grade, lymphovascular space invasion (LVSI), skin or nipple infiltration, perineural invasion, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 status. The odds ratio of each variable was evaluated using ordinal regression analysis.
RESULTS Stage 3 breast cancer had the worst status of ALN involvement compared with stage 1 (OR = 3.49; 95% CI = 1.51–8.08) and stage 2 (OR = 3.04; 95% CI = 1.32–6.98). Likewise, positive LVSI also had the worst status of ALN involvement compared with negative LVSI (OR = 8.68; 95% CI = 4.23–17.81).
CONCLUSIONS Tumor stage and LVSI could be considered as independent predictive factors of ALN involvement in patients with breast cancer, especially among Indonesian women.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-86. https://doi.org/10.1002/ijc.29210
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. https://doi.org/10.3322/caac.21492
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 estimated cancer incidence, mortality and prevalence worldwide in 2012 v1.0: IARC Cancer Base No. 11 [Internet]. Lyon: International Agency for Research on Cancer; 2013 [cited 2016 Mar 7]. Available from: http://globocan.iarc.fr.
Ng CJ, Teo CH, Abdullah N, Tan WP, Tan HM. Relationships between cancer pattern, country income and geographical region in Asia. BMC Cancer. 2015;15:613. https://doi.org/10.1186/s12885-015-1615-0
Karatas F, Sahin S, Erdem GU, Ates O, Babacan T, Akin S, et al. Left laterality is an independent prognostic factor for metastasis in N3 stage breast cancer. J BUON. 2016;21(4):851-8.
Nouh MA, Ismail H, El-Din NH, El-Bolkainy MN. Lymph node metastasis in breast carcinoma: clinicopathological correlations in 3747 patients. J Egypt Natl Canc Inst. 2004;16(1):50-6.
Gabriel N, James L, Carl J, Stephen B, Elizabeth A, Hope S, et al. Breast. In: Mahul B, editor. American Joint Committee on Cancer (AJCC) cancer staging manual. 8th ed. New York: Springer; 2017. p. 589-628.
Tavassoli FA, Devilee P. Pathology and genetics: tumours of the breast and female genital organs. WHO Classification of Tumours series - volume IV. Lyon: IARC Press; 2003. p. 18-9.
Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College of American Pathologists Guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010;28(16):2784-95. https://doi.org/10.1200/JCO.2009.25.6529
Ali EM, Ahmed AR, Ali AM. Correlation of breast cancer subtypes based on ER, PR and HER2 expression with axillary lymph node status. Cancer Oncol Res. 2014;2(4):51-7. https://doi.org/10.13189/cor.2014.020402
Smith TJ, McKenna CM. An examination of ordinal regression goodness-of-fit indices under varied sample conditions and link functions. Multiple Linear Regression Viewpoints. 2012;38(1):1-7.
Lale Atahan I, Yildiz F, Ozyigit G, Sari S, Gurkaynak M, Selek U, et al. Percent positive axillary lymph node metastasis predicts survival in patients with non-metastatic breast cancer. Acta Oncol. 2008;47(2):232-8. https://doi.org/10.1080/02841860701678761
Wallgren A, Bonetti M, Gelber RD, Goldhirsch A, Castiglione- Gertsch M, Holmberg SB, et al. Risk factors for locoregional recurrence among breast cancer patients: results from International Breast Cancer Study Group Trials I through VII. J Clin Oncol. 2003;21(7):1205-13. https://doi.org/10.1200/JCO.2003.03.130
Hadi NI, Jamal Q. Comparison of clinicopathological characteristics of lymph node positive and lymph node negative breast cancer. Pak J Med Sci. 2016;32(4):863-8. https://doi.org/10.12669/pjms.324.10324
Oliveira Filho HR, Dória MT, Piato JR, Soares Junior JM, Filassi JR, Baracat EC, et al. Criteria for prediction of metastatic axillary lymph nodes in early-stage breast cancer. Rev Bras Ginecol Obstet. 2015;37(7):308-13. https://doi.org/10.1590/S0100-720320150005343
Ding J, Jiang L, Wu W. Predictive value of clinicopathological characteristics for sentinel lymph node metastasis in early breast cancer. Med Sci Monit. 2017;23:4102-8. https://doi.org/10.12659/MSM.902795
Blackburn HL, Ellsworth DL, Shriver CD, Ellsworth RE. Breast cancer metastasis to the axillary lymph nodes: are changes to the lymph node "soil" localized or systemic? Breast Cancer. 2017:11:1178223417691246. https://doi.org/10.1177/1178223417691246
Gismalla M, Elhassan M, Abass M. Clinical and pathological factors predicting axillary nodal metastasis in breast cancer patients of central Sudan: a single institution experience. Saudi J Health Sci. 2019;8(3):146-50. https://doi.org/10.4103/sjhs.sjhs_90_19
Chandrashekar S, Ajith VL, Ashwin Raghavendra A. Axillary lymph node status, age at presentation and menopausal status in female breast cancer patients attending a government tertiary care teaching hospital in Mysore, Karnataka, India. Int Surg J. 2017;4(5):1566-8. https://doi.org/10.18203/2349-2902.isj20171510
Chollet-Hinton L, Anders CK, Tse CK, Bell MB, Yang YC, Carey LA, et al. Breast cancer biologic and etiologic heterogeneity by young age and menopausal status in the Carolina Breast Cancer Study: a case-control study. Breast Cancer Res. 2016;18(79). https://doi.org/10.1186/s13058-016-0736-y
Roychoudhuri R, Putcha V, Møller H. Cancer and laterality: a study of the five major paired organs (UK). Cancer Causes Control. 2006;17(5):655-62. https://doi.org/10.1007/s10552-005-0615-9
Amer MH. Genetic factors and breast cancer laterality. Cancer Manag Res. 2014;6:191-203. https://doi.org/10.2147/CMAR.S60006
Melnik Y, Slater P, Steinitz R, Davies A. Breast cancer in Israel: laterality and survival. J Cancer Res Clin Oncol. 1979;95(3):291-3. https://doi.org/10.1007/BF00410651
Ing R, Petrakis NL, Ho JH. Unilateral breast-feeding and breast cancer. Lancet. 1977;2(8029):124-7. https://doi.org/10.1016/S0140-6736(77)90131-3
Anstey EH, Shoemaker ML, Barrera CM, O'Neil ME, Verma AB, Holman DM. Breastfeeding and breast cancer risk reduction: implications for black mothers. Am J Prev Med. 2017;53(3S1):S40-6. https://doi.org/10.1016/j.amepre.2017.04.024
Lee SY, Kim MT, Kim SW, Song MS, Yoon SJ. Effect of lifetime lactation on breast cancer risk: a Korean women's cohort study. Int J Cancer. 2003;105(3):390-3. https://doi.org/10.1002/ijc.11078
Moosavi SA, Abdirad A, Omranipour R, Hadji M, Razavi AE, Najafi M. Clinicopathologic features predicting involvement of non-sentinel axillary lymph nodes in Iranian women with breast cancer. Asian Pac J Cancer Prev. 2014;15(17):7049-54. https://doi.org/10.7314/APJCP.2014.15.17.7049
Friedman D, Gipponi M, Murelli F, Meszaros P, Solari N, Massa M, et al. Predictive factors of non-sentinel lymph node involvement in patients with invasive breast cancer and sentinel node micrometastases. Anticancer Res. 2013;33(10):4509-14.
Dong G, Wang D, Liang X, Gao H, Wang L, Yu X, et al. Factors related to survival rates for breast cancer patients. Int J Clin Exp Med. 2014;7(10):3719-24.
Camacho-Rivera M, Ragin C, Roach V, Kalwar T, Taioli E. Breast cancer clinical characteristics and outcomes in Trinidad and Tobago. J Immigrant Minority Health. 2015;17:765-72. https://doi.org/10.1007/s10903-014-0020-0
Song YJ, Shin SH, Cho JS, Park MH, Yoon JH, Jegal YJ. The role of lymphovascular invasion as a prognostic factor in patients with lymph node-positive operable Invasive breast cancer. J Breast Cancer. 2011;14(3):198-203. https://doi.org/10.4048/jbc.2011.14.3.198
Ryu YJ, Kang SJ, Cho JS, Yoon JH, Park MH. Lymphovascular invasion can be better than pathologic complete response to predict prognosis in breast cancer treated with neoadjuvant chemotherapy. Medicine. 2018;97(30):e11647. https://doi.org/10.1097/MD.0000000000011647
Copyright (c) 2020 Dody Novrial, Gita Nawangtantrini, Hidayat Sulistyo, Henida Dwi Sari, Wahyu Djatmiko
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.